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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610406
Report Date: 01/14/2025
Date Signed: 01/14/2025 11:49:49 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2025 and conducted by Evaluator Leizl De La Cerra
COMPLAINT CONTROL NUMBER: 31-AS-20250109083527
FACILITY NAME:AMAZING ANGELSFACILITY NUMBER:
197610406
ADMINISTRATOR:WERDIAN, LUSINEFACILITY TYPE:
735
ADDRESS:14268 PIERCE STTELEPHONE:
(818) 455-9929
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY:4CENSUS: 4DATE:
01/14/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Lusine Werdian, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Licensee did not follow proper eviction procedures for resident.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced initial complaint visit to the facility. Upon entry, LPA was met with the facility administrator, Lusine Werdian and explained the reason for the visit.
Allegation: Licensee did not follow proper eviction procedures for resident.
It was alleged that licensee did not follow proper eviction procedures for resident, R1. To investigate the allegation, on 01/14/2025 at 11:00AM, LPA conducted a physical plant tour, interviewed one (01) staff member and interviewed three (03) clients, conducted record reviews between 11:30PM to 2:30PM. A review of the eviction notice that was provided to a client (C1) of the facility on 1/07/2024 reveals a reason of why S1 is evicting C1. During the interview with the staff administrator (S1), S1 admitted to LPA a diferent reason of why S1 was evicting C1. The reason S1 verbally told LPA does not match the reason written on the eviction notice. Interview with S1 and review of the eviction notice also revealed that S1 did not provide specific facts that supports the reason for the eviction.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 31-AS-20250109083527
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: AMAZING ANGELS
FACILITY NUMBER: 197610406
VISIT DATE: 01/14/2025
NARRATIVE
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Based on observation, interviews and record reviews, there was enough supporting information to confirm the allegation. Therefore, the allegation is deemed Substantiated at this time.

Per CA Code of Regulations, Title 22 Division 6, Chapter 8, the following deficiency was cited and recorded on LIC9099-D.

Exit interview conducted. Appeal rights were discussed, and a copy of the report will be given to administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250109083527
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: AMAZING ANGELS
FACILITY NUMBER: 197610406
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/14/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2025
Section Cited
CCR
80068.5(c)
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80068.5 Eviction Procedures
c) The notice to quit shall state the reasons for the eviction, with specific facts supporting the reason for the eviction including the date, place, witnesses, if any, and circumstances.
This requirement is not met as evidenced by;
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POC: Licensee/Administrator will submit a written letter stating they have reviewed 80068.5 Eviction Procedures and that going forward will adhere to the regulation.
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 the licensee provided an eviction notice that was missing valid information that pertains to the regulation above. this posses a potential health and safety or personal rights risks to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Leizl De La Cerra
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3